An elderly Syrian refugee suffering from Parkinson's disease sleeps in a room in a ramshackle home on a cattle ground in Tripoli, Lebanon, surrounded by his daughter-in-law and granddaughter

GENEVA/BEIRUT, FEBRUARY 7, 2013—Syrians who have fled violent conflict at home to seek safety in Lebanon do not receive anywhere near adequate levels of humanitarian assistance and are living in extremely precarious conditions, a detailed survey released today by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) reveals.

The MSF report, “Misery Beyond the War Zone,” shows that of the 220,000 Syrians who have sought refuge so far in Lebanon, many cannot obtain necessary health care, among other worrying findings. The survey, which follows a similar study carried out by MSF six months ago, reveals a marked deterioration of the humanitarian situation in Lebanon, in large part due to extremely lengthy registration delays. Refugees in Lebanon are not entitled to formal assistance if they are not registered. Lebanon is home to the largest number of Syrian refugees.

“Registration should not be a condition for receiving assistance in any emergency crisis,” said MSF General Director Bruno Jochum. “Yet access to humanitarian aid is seriously hampered by the difficulties many refugees encounter in registering on arrival in Lebanon. The roll out of aid must be accelerated and expanded,” he said.

Syrian refugees and other displaced people in Lebanon do not have access to free health care and adequate shelter. Living conditions for the majority of refugees and Lebanese returnees remain extremely precarious. More than 50 percent of people surveyed by MSF, whether officially registered or not, are housed in substandard structures in inadequate collective shelters, farms, garages, unfinished buildings, and old schools. Most provide paltry protection against the elements, if any at all.

Dire living conditions are contributing to deteriorating health conditions. Children are especially susceptible to skin and respiratory diseases.

The survey, completed in late December 2012, involved 2,100 Syrian refugee families. Seventy-five percent of the respondents were living in conditions utterly unsuitable for the hardships of winter. People registered with the United Nations High Commission for Refugees (UNHCR) are entitled to food and fuel vouchers and coverage of health care costs, but more than 40 percent of those surveyed were not officially registered.

“We are in an extreme situation, we don’t have enough food, and we don’t know who to go to for help,” said one Syrian refugee, a father of four children aged five months to thirteen years, who fled with his family to Lebanon from the war-torn city of Homs. “The only food we receive is purely out of solidarity of our Lebanese neighbors. As adults we can eat once a day, but we cannot tell our children to do the same. If we didn’t fear the bombing in Homs we would go back immediately.”

Roughly one in four of the interviewees said they had not received any assistance, while 65 percent said they had received only partial assistance that did not cover their families’ needs. In most parts of Lebanon, the capacity of host communities to absorb refugees has reached its limit. Families that arrived earlier are fast running out of money to pay for food and shelter and have no access to basic medical care.

“The authorities and relief agencies must accelerate the establishment of reception centers for newly arriving refugees and immediately make available collective shelters adapted to winter conditions, in order to cope with the increasing influx of refugees.”

The medical situation has clearly deteriorated over the past six months. More than half of all interviewees (52 percent) cannot afford treatment for chronic diseases and nearly one-third of respondents were forced to suspend treatment due to cost. Child vaccinations, prescription drugs, prenatal and obstetric care, and basic health maintenance are often out of reach.

Access to medical services for the most vulnerable populations—whether they are registered or non-registered, Palestinians refugees from Syria or Lebanese returnees—must be made an immediate priority and acted upon, MSF said. All refugees must be provided with assistance immediately upon arrival in Lebanon and guaranteed access to health care.

“It is time for donors to truly commit themselves to addressing the growing needs of the refugee population in Lebanon, and for national and international aid actors to evaluate the methods and the amount of aid they are providing,” said Jochum.

MSF has been providing humanitarian assistance to Syrian refugees in Lebanon since November 2011. In 2012, MSF carried out more than 22,000 consultations in the Bekaa Valley and in Tripoli. Since November 2012, MSF distributed 25,580 basic relief items to Syrian refugees scattered throughout the Bekaa Valley. In mid-January 2013, MSF began distributing fuel vouchers to refugees, with 300 families now able to have heat for two months. As of today, MSF has doubled its staff from 50 to 112 and its operational response is scaling up.

In Syria, MSF is working in three hospitals in the north of Syria, in areas controlled by armed opposition groups. Medical teams provide emergency care, surgery, and maternal health care. Between June 2012 and early January 2013, MSF teams conducted more than 11,000 consultations and performed more than 1,200 surgical interventions. MSF is also providing medical and surgical services to Syrian, Palestinian, and Iraqi refugees in Jordan, Lebanon, and Iraq.